High-Cost Dual Eligibles' Service Use Demonstrates The Need For Supportive And Palliative Models Of Care
High-Cost Dual Eligibles' Service Use Demonstrates The Need For Supportive And Palliative Models Of Care
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DOI：
10.1377/hlthaff.2017.0157
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发表时间：
2017-07-01
期刊：
影响因子：
9.7
通讯作者：
Meara, Ellen
中科院分区：
文献类型：
--
作者：
Bynum, Julie P. W.;Austin, Andrea;Meara, Ellen
医疗保健支出通常在既需要复杂医疗保健又需要长期服务和支持的人群中最高，例如有资格享受医疗保险和医疗补助的成年人。了解不同类型的复杂患者如何随着时间的推移使用服务可以为针对这一人群的政策提供信息。医疗保险和医疗补助的高综合支出出现在两个不同的高成本双重资格群体中：接近生命终点的老年受益人和持续需要功能支持的年轻受益人。然而，这两组患者的住院费用都很高。在生活在社区的高成本双重资格者中，年龄较大的人在家庭和社区服务上的支出低于年龄较小的人。在生命的最后一两年，当疾病和功能衰退加速时，更多地使用这些服务可能会提供稳定的支持。针对每个人群的独特需求量身定制的方法可以为患者及其家属带来更大价值的护理，如果患者的需求可以通过减少短期住院设施的住院时间来满足，则有可能降低成本。
Health care spending is generally highest among people who need both complex medical care and long-term services and supports, such as adults dually eligible for Medicare and Medicaid. Understanding how different types of complex patients use services over time can inform policies that target this population. High combined Medicare and Medicaid spending are found in two distinct groups of high-cost dual eligibles: older beneficiaries who are nearing the end of life, and younger beneficiaries with sustained need for functional supports. However, both groups have high hospitalization costs. Among high-cost dual eligibles living in the community, those who are older spend less on home and community-based services than those who are younger. Greater use of such services might provide stable support in the last year or two of life, when illness and functional decline accelerate. Tailored approaches to each population's distinct needs could yield care of increased value to patients and their families, with the potential to lower costs if patients' needs can be met with fewer stays in short-term inpatient facilities.